Age-related patterns in hysterectomy: indications and surgical route selection in a three-year tertiary-center cohort.

BACKGROUND

Hysterectomy indications and surgical route selection may vary with age due to shifting case mix.

OBJECTIVES

To describe age-stratified hysterectomy indications and routes and identify factors independently associated with route selection.

DESIGN

Retrospective chart review.

SETTINGS: Single-center, tertiary-care teaching and research hospital, Department of Obstetrics and Gynecology.

METHODS

Hysterectomies performed for benign or premalignant indications between 2022 and 2024 were identified and verified. Patients were grouped according to age [<50, 50-59, or ≥60 years]. Indications were assigned using PALM-COEIN and grouped clinically. Routes were categorized as open abdominal, laparoscopic/VNOTES, or vaginal. Comparisons used Kruskal-Wallis and chi-square tests. Multinomial and binary logistic regression adjusted for age group, parity, comorbidity, smoking, and prior pelvic/abdominal surgery.

MAIN OUTCOME MEASURES: age-stratified hysterectomy route and age-stratified indications and predictors of minimally invasive versus open surgery.

SAMPLE SIZE: 769 hysterectomies.

RESULTS

Primary indications differed significantly by age group (P<.001; Cramer's V=0.38): treatment-resistant abnormal uterine bleeding predominated in patients <50 and 50-59 years, whereas pelvic organ prolapse predominated in patients ≥60 years. Surgical route also varied by age (P<.001; Cramer's V=0.34): open abdominal hysterectomy decreased from 47.3% in patients <50 years to 15.3% in those ≥60 years, while vaginal hysterectomy increased from 4.0% to 52.6%. In multinomial regression, age ≥60 years was associated with higher odds of laparoscopic/VNOTES versus open surgery (aOR 1.97, 95% CI 1.08-3.61) and vaginal versus open surgery (adjusted odds ratio, aOR 21.60, 95% confidence interval, CI 10.02-46.60). In binary regression, age ≥60 years (aOR 4.18, 95% CI 2.41-7.26) and parity (aOR 1.18 per birth, 95% CI 1.06-1.32) favored minimally invasive surgery.

CONCLUSIONS

Age-related indication shifts accompanied major route changes, with greater vaginal and minimally invasive use among older patients.

LIMITATIONS: Single-center retrospective design; residual confounding by indication and uterine size; conversions and standardized complications were not analyzed; unmeasured clinical/surgeon factors.